It Started With A Quip And Ended With Corporation Culture

Monday, 5 September 2022, 5:12 am
Opinion: Ian Powell

Hot Chocolate’s ‘It Started with a Kiss’, first released in 1982, is a sweet romantic tune which reached Number 5 in the United Kingdom charts:  Hot Chocolate: It started with a kiss.

If ‘kiss’ was replaced with ‘quip’ the last chorus would be:

It started with a quip
Never thought it would come to this
It started with a quip, oh
Never thought it would come to this

“Operating in secrecy”

Minus the romance, starting with a quip leads on to a mainstream media heading for an article that Minister of Health Andrew Little and Prime Minister Jacinda Ardern did not want to see: New health authority accused of ‘operating in secret’ over closed-door meetings. It was the heading for an article by Stuff senior health reporter Rachel Thomas (31 August).

Adding to the political anguish was the fact that this article was front page on Wellington’s DomPost: Te Whatu Ora (Health NZ) accused of operating in secrecy.

The article reported worries and fears from patient advocates that their voices would “be silenced in Aotearoa New Zealand’s newly restructured more centralised health system.

The catalyst was the defence by Chairperson Rob Campbell’s defence of the two-month old Te Whatu Ora’s (Health New Zealand – HNZ) decision to keep the media and public out of its board meetings.

This contrasts with the now abolished district health boards’ (DHBs) practice of having board meeting public sessions (there were also private sessions largely for confidential and commercially sensitive matters).

The quip in context

Thomas was following on from an interview with a Radio New Zealand interview with Campbell by Guyon Espiner two days earlier on Morning Report: No providing “occupational therapy for journalists”.

Essentially Campbell’s argument was that Te Whatu Ora was a crown entity quite different from the DHBs which it replaced and, unlike them, was not required by legislation to have public sessions at board meetings.

Further, there was nothing unusual for a crown entity to have private sessions only for board members. An unconvincing argument in my view.

But the punchline came with his comment towards the end of the interview when he quipped that Te Whatu Ora was not about providing “…occupational therapy for journalists.” Campbell is an intelligent and charming personality with a dry but clever sense of witty quips.

In a different context, his quip might have been interpreted as funny. But not in this context. Transparency is critical for the credibility of health systems; both perceived and real threats to transparency raise alarm bells among the public and many of those working in the system.

The lesson for Campbell is beware of the quick quip; it can bite you in the bum. But I had better be careful or words like throwing stones and glass houses might come to mind.

The quip raises the wider issue of leadership culture. Already, after only two months, Health New Zealand has earned the descriptor of behaving and looking like a corporation. This is the worst image it could have.

Rob Campbell’s pre-quip defence in the Morning Report interview is where the greater scrutiny should be. Te Whatu Ora is a crown entity but so were DHBs. He argued that his crown entity’s approach was the same as other existing entities. This is a weak comparison.

DHBs were responsible for the healthcare of geographically defined populations. They prepared reports to their governing boards on how they were doing this. The media and interested organisations and people could access the agenda for these meetings which meant they could also access the reports listed on the agenda.

In my three decades working for the Association of Salaried Medical Specialists I was impressed with the way in which many journalists used this material to research good public interest stories.

But early signs to date suggest that either less is being written or less is being required to be reported to Campbell’s board. This has the immediate effect of reducing transparency.

The controversy is described well by political commentator Bryce Edwards in a piece published by his Democracy Project (31 August): Government must make healthcare transparent again.

Corporation culture

For me the controversy is wider, however, than the points discussed above. The description of Health New Zealand as a corporation is concerningly apt with a certain unfortunate resonance with the National government’s health restructuring of the 1990s.

At that time healthcare was, in effect, treated as a commodity in a competitive market while disingenuously pretending it was still a public good. Public hospitals were covered by the Commerce and Companies Acts, and required  to compete against each other and the private sector. Media and the public were excluded from the meetings of their governing boards.

Helen Clark’s Labour-led government (1999-2008) repealed all of that with a well-managed smooth restructuring that included the creation of DHBs. The system remained substantially unchanged under the National-led government that followed (2008-17).

An ABC of health systems

Not so with Jacinda Ardern’s Labour government. The Pae Ora Act, replacing DHBs with Te Whatu Ora, is not a return to the 1990s treating of health as a commodity in an artificially created market. But it has consciously created an environment in which its body responsible for funding, planning and the provision of healthcare looks, smells and behaves like a corporation.

Rob Campbell was correct when he said that while the legislation that created DHBs required their board meetings to have public sessions (and all that flowed from that), the legislation that created his replacement organisation did not.

This was not an accident; it was deliberate. It was an important part of the new health system culture the Government chose to introduce.

Campbell and his Te Whatu Ora board are not the cause of the controversy. His quip simply gave it more exposure than otherwise might have been the case. The simple fact is that the more that health systems are centralised, the more their transparency is reduced. Then, the more transparency is reduced, the more accountability is reduced.

A universal health system suffers under a corporation culture. Te Whatu Ora is not like other crown entities. It is responsible for a health system that at some point in their lives all New Zealanders will depend on. These same New Zealanders fund it. It requires a culture of greater, not lesser, public transparency and accountability.

This is an ABC of universal health systems.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Salaried Medical Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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